Optimizing the Readability of Patient Education Materials on Seizure Rescue Medications
Tasneem Karim, MD1, Sean Woods1, Bethanie Morgan, MD2
1University of Louisville School of Medicine, 2Kentucky Office of Children with Special Healthcare Needs (OCSHCN)
Objective:

Evaluate the readability, understandability, actionability, and clarity of freely available online patient education materials (PEM) on seizure rescue medications.

Background:

Low health literacy can negatively impact the treatment of acute seizures in non-medical settings. Specifically, proper administration of seizure rescue medications can be affected when there are gaps in understanding by caregivers. The American Medical Association (AMA) and National Institutes of Health (NIH) recommend that PEMs are written at or below the sixth and eighth grade reading levels, respectively. The Simple Measure of Gobbledygook (SMOG) scale approximates the grade or education level needed to understand written materials, but it does not assess other critical aspects of overall text difficulty. When coupled with the SMOG scale, the Patient Education Materials Assessment Tool (PEMAT) and the Clear Communication Index (CCI) provide a complete assessment of the understandability, actionability, and clarity of PEMs. 

Design/Methods:

To identify PEMs, we conducted an environmental scan of academic databases, professional organizations, patient-facing databases, and a consumer search engine. We applied three validated health literacy tools (SMOG, PEMAT, and CCI) to each PEM and analyzed correlations between scores.

Results:

A total of 40 PEMs met inclusion criteria – 18 from a consumer search engine, 14 from professional organizations, and 8 from patient-facing databases. Among all PEMs, the average SMOG score was 12.01 (SD ±1.38), (range 8.8 - 14.9).

Conclusions:
All PEMs exceeded the recommended grade levels, with the average PEM written at six and four grade levels higher than what is recommended by the AMA and NIH, respectively. This suggests limited efficacy of PEMs in populations with variable reading abilities. Supplemental assessment of the PEMs using the PEMAT and CCI will provide additional insight. These results may guide future PEM authors to write more effective materials, thereby promoting health equity in the management of acute seizures.
10.1212/WNL.0000000000211087
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